Services & Procedures
Dr Gretz and Chuang are devoted to providing the full range of gynecologic oncology and gynecologic surgical services. If you would like more information on the services provided, please call our office or speak with your doctor.
Gynecologic Oncology
- Uterine or Endometrial Cancer
- Cervical Cancer
- Radical Hysterectomy
- Radical Trachelectomy
- Colposcopy
- Ovarian Cancer
- Ovarian Cancer Screening
- BRCA Analysis and Management
- Chemotherapy
Minimally Invasive Surgery
- Advanced Laparoscopic & Hysteroscopic Surgery
- da Vinci® Hysterectomy
- da Vinci® Myomectomy
Minimally Invasive Surgery Benefits
- Decreased postoperative pain and use of medications
- Shortened hospital stay
- Rapid return to normal activities
Gynecology
- Endometriosis Management
- Myomectomy
- Endometrial Ablation
- Hysterectomy Alternatives and Fibroid Treatment Options
Fibroids
What Are Uterine Fibroids?
Uterine fibroids (UF), also known as uterine leiomyomata, are the most common
non-cancerous tumors in women of childbearing age. The tumors arise from muscle
cells and other tissues within the wall of the uterus. Fibroids can occur as
individual tumors or as clusters of tumors of varying sizes.
- Subserosal Fibroids
These fibroids develop in the outer portion of the uterus and continue to grow outward. - Intramural Fibroids
The most common type of fibroid, which develops within the uterine wall and expands making the uterus feel larger than normal (which may cause "bulk symptoms"). - Submucosal Fibroids
These fibroids develop just under the lining of the uterine cavity. These are the fibroids that have the most effect on heavy menstrual bleeding and the ones that can cause problems with infertility and miscarriage. - Pedunculated Fibroids
Fibroids that grow on a small stalk which connects them to the inner or outer wall of the uterus.
Until recently, treatment for symptomatic uterine fibroids was invasive or minimally invasive surgery, while drug therapy provided only short-term symptom relief or required some form of invasive surgery. As a result many patients suffer with symptoms, taking a wait-and-see approach.
In October 2004, the U.S. Food and Drug Adminstration (FDA) approved ExAblate® 2000, which uses Magnetic Resonance guided Focused Ultrasound to treat symptomatic uterine fibroids, offering patients an important new treatment option. The FDA expedited approval of the ExAblate 2000 system because it “offers significant advantages over existing treatments for uterine fibroids,” according to the agency.
Who Gets Uterine Fibroids?
According to the U.S. National Institutes of Health, at least 25 percent of women suffer from uterine fibroids. As many as 77 percent of women may actually have the condition, but may be unaware of it because they exhibit few or no symptoms. Although the cause of uterine fibroids is still unknown, several factors have been found to increase or decrease the risk of developing them:
- African-American women have a three to five times greater risk for developing uterine fibroids than Caucasian women.
- Women who are obese or overweight have a slightly higher risk for developing uterine fibroids than women of normal weight.
- Women who have given birth have a lower risk of developing uterine fibroids than women who have not.
What are the Symptoms of Uterine Fibroids?
- Heavy bleeding or painful periods
- Frequent urination (results from a fibroid pressing on the bladder)
- Bleeding between periods
- Pain during sex
- Feeling "full" in the lower abdomen
- Lower back pain
How Are Uterine Fibroids Treated?
The choice of treatment depends on several factors, including degree and frequency of symptoms, fertility considerations, fibroid size, patient age and a patient’s willingness to undergo invasive procedures. Upon detection of uterine fibroids, if symptoms are not severe, women often are counseled to take a watchful waiting approach to see if symptoms worsen. Pain medication (over-the-counter or prescription) may be sufficient to treat intermittent pain or mild symptoms. For women with more severe symptoms, the goal of therapy has been to remove or reduce the size of the tumor(s).
Fibroid Treatment Options
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Procedure |
What is it? |
Advantages |
Disadvantages |
|---|---|---|---|
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Hysterectomy Laparoscopic Hysterectomy Supra-Cervical Hysterectomy da Vinci Hysterectomy |
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Abdominal myomectomy |
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Laparoscopic or hysteroscopic myomectomy |
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Uterine artery embolization |
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Magnetic Resonance guided Focused Ultrasound |
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Hormone therapy |
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Watchful waiting |
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ExAblate: Am I a candidate
Ask your physician if you are a candidate. He or she will be able to tell you if you are a suitable candidate for the ExAblate treatment. In general, people who cannot go into an MRI will not be able to have the ExAblate treatment – this includes patients with metallic implants, patients who are claustrophobic, and patients who are allergic to contrast agent, a dye used to see blood vessels during MR imaging. ExAblate treatment is not intended for women who are pregnant or desire future pregnancy. The effects of ExAblate on the ability to become pregnant and carry a fetus to term, and on the development of the fetus, have not yet been determined.
Your physician will determine if your fibroids are suitable for treatment. During your gynecological examination, your doctor will check the size of your uterus. If it feels enlarged, your doctor may order an abdominal or transvaginal ultrasound or a magnetic resonance (MR) imaging session, which can confirm the presence, location and size of fibroids. After identifying the size and location of your fibroids, and possibly after other diagnostic tests, your doctor may be able to rule out other conditions, advise you of your options and recommend a course of treatment for fibroids.
ExAblate can be used for submucosal, subserosal, and intramural uterine fibroids. These are terms that are used to describe the location of the fibroid within the uterus. More than one fibroid can be treated. Fibroids that are pedunculated (hanging from a stalk), in close proximity to sensitive organs (such as bowel or bladder), or in a location inaccessible by the focused ultrasound may be untreatable.
ExAblate FAQs
What is the ExAblate 2000 treatment?
It is a only non-invasive surgical procedure that has been approved by the FDA to treat uterine fibroids using focused ultrasound. Ultrasound waves are high frequency sound waves that the human ear cannot hear. When they are focused, similar to how a magnifying glass focuses light waves, heating of fibroid tissue occurs at the focus. The ExAblate device uses MR images to allow the doctor to see inside your body and locate where the fibroid is. During the treatment, MR images allow the doctor to see what temperatures the fibroid has reached, and after treatment, MR images allow the doctor to see how successful the treatment has been.
I think I might have fibroids – how can I tell?
Only your physician can diagnose fibroids. If you are experiencing any of the following symptoms of fibroids, you may wish to speak with him or her:
- Very heavy and prolonged monthly periods, sometimes with clots
- Pain in the back or in the legs
- Pelvic pain or pressure
- Pain during sexual intercourse
- Pressure on the bladder which leads to a constant need to urinate, incontinence, or the inability to empty the bladder
- Pressure on the bowel which can lead to constipation and/or bloating
- An enlarged abdomen which may be mistaken for weight gain or pregnancy
How will my physician tell if I have fibroids?
During your gynecological examination, your doctor will check the size of your uterus. If it feels enlarged, your doctor may order an abdominal or transvaginal ultrasound or a magnetic resonance (MR) imaging session, which can confirm the presence, location and size of fibroids. After identifying the size and location of your fibroids, and possibly after other diagnostic tests, your doctor may be able to rule out other conditions, advise you of your options and recommend a course of treatment for fibroids.
What types of fibroids can be treated with the ExAblate 2000?
Your physician will determine if your fibroids are suitable for treatment. ExAblate can be used for submucosal, subserosal, and intramural uterine fibroids. These are terms that are used to describe the location of the fibroid within the uterus. More than one fibroid can be treated. Fibroids that are pedunculated (hanging from a stalk), in close proximity to sensitive organs (such as bowel or bladder), or in a location inaccessible by the focused ultrasound may be untreatable.
What is the treatment like?
The entire procedure takes place with you lying in an MR scanner. The doctor will first take some MR images of your pelvic area to locate your uterus and your fibroid(s). Then, he will use these images to develop a treatment plan. When the treatment begins, a small beam of focused ultrasound is directed at the target for approximately 15 seconds and heats the tissue. MR images are taken during each heating cycle provide an image of the target tissue and the degree of heating. The system then moves to the next treatment point, and the process is repeated about once every 90 seconds until the entire volume has been treated. Typically, 30-100 individual pulses are delivered over a 3-hour period to complete a treatment. After the treatment, more MR images are taken to determine how successful the treatment was.
What will I be required to do during the treatment?
In order to have a successful treatment, it will be very important that you lie very still during the procedure. The doctor will give you some sedatives and pain medication to help you relax. The doctor also will talk with you throughout the procedure to see how you are feeling. You will be able to talk to the doctor and tell him or her if something is bothering you.
How long will the treatment last?
You will lie on the patient table inside an MRI for 3-4 hours depending on the size of your fibroid(s).
What will I feel during the treatment?
Women have reported feeling a warming sensation on their skin or inside the pelvic region. You may feel a 'pinch' or something like a brief menstrual cramp when the energy is being delivered. During the treatment, the doctor will advise you of sensations that are normal and instruct you to stop the treatment if you experience sensations that are not normal, using a button that you will hold in your hand.
What happens to me after the treatment?
The ExAblate treatment is performed as an outpatient procedure that takes 3-4 hours. Following the treatment you will rest for additional 1-2 hours.
Based on how you are feeling, you will receive discharge instructions from your doctor regarding medications you may need to take to keep you comfortable. Usually, over-the-counter pain relief medication is all that is required. You may experience some cramping, similar to menstrual period cramping; or shoulder or back pain that lasts a few days after the procedure from lying in the treatment position.
Most women are able to return to work and normal activity within 1-2 days.
Who provides my post-procedural care / what will I need to do after the treatment?
It is important that you and your doctor discuss who will handle your follow-up care, phone calls and/or office visits, after the procedure. You should also know who to contact in case of an emergency after your procedure. This is especially important if you are experiencing fever, pelvic pain, or foul-smelling vaginal discharge after the procedure that increases over time and lasts more than 24 hours.
How soon will I start to feel better?
Depending on initial symptoms, most patients find relief in their fibroid-related symptoms within 3 months, as shown by a clinical study conducted by InSightec.
I recently had a myomectomy but my fibroids are still bothering me – can I get this treatment?
Your doctor would be the best person to talk to about this. Depending on how the surgery was performed, patients that have scar tissue on their abdomen from myomectomy or a previous surgery/C-section may not be eligible for the treatment since focused ultrasound may cause heating or skin burns when large scar tissue is present.
I previously had a Uterine Artery Embolization/Uterine Fibroid Embolization – can I still get this treatment?
Uterine Artery Embolization involves the injection of microbeads made of poly-vinyl alcohol or other materials that block the small vessels of the fibroid and uterus. There were no patients with previous UFE/UAE treatment in the previous clinical studies, and the risks are unknown at this time.
What should I tell my doctor about my health before this treatment?
Before you undergo ExAblate treatment you should discuss:
- Your personal health history, including any allergies you may have
- Your families health history
- Any recent illnesses
- Medicines, include both prescription, over the counter and herbal medicines or dietary supplements
- Recent activities, including travel
- Your level of normal physical activity
- Previous MR or CT imaging studies
What are my other treatment alternatives?
Your physician would be the best person to discuss treatment alternatives with you. Other available treatments are:
- Watchful waiting
- Hysterectomy
- Abdominal myomectomy
- Laparoscopic or hysteroscopic myomectomy
- Uterine artery embolization
- Hormone Therapy
Could my fibroids come back after the treatment?
Although this treatment may be successful in destroying the fibroids causing painful symptoms, at a later time, more fibroids may grow, become symptomatic and require additional treatment. This is true for all fibroid treatments, except hysterectomy where the entire uterus is removed. In the clinical trial, 21% of the subjects had alternative surgical treatment for their fibroids within 1 year of the treatment with ExAblate.
Are there any risks to the treatment?
As with any medical procedure, there are risks involved in the ExAblate treatment. Your physician would be the best person to talk to about this.
What other tumors are being treated using ExAblate 2000?
Clinical trials for verifying the safety and efficacy of the MRgFUS technology (or ExAblate) are being conducted for, bone metastases, breast cancer, brain tumors, liver and prostate cancer. For more information please check the InSightec website. (www.insightec.com)
How many patients have been treated so far?
Over 3,500 patients have been treated in the US and around the world.